Healthcare Provider Details

I. General information

NPI: 1285492025
Provider Name (Legal Business Name): HYDE PARK VIRTUAL COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2024
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11427 REED HARTMAN HWY # 225
BLUE ASH OH
45241-2418
US

IV. Provider business mailing address

11427 REED HARTMAN HWY # 225
BLUE ASH OH
45241-2418
US

V. Phone/Fax

Practice location:
  • Phone: 513-310-8408
  • Fax:
Mailing address:
  • Phone: 513-310-8408
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name: MRS. MEGAN JACK
Title or Position: SOLE PROPRIETOR
Credential:
Phone: 303-898-2265